Affordable Care Act FAQ
ACA Form 1095 Questions
What is IRS Form 1095?
The Affordable Care Act (ACA) requires that certain employers provide you with an IRS tax form called Form 1095-C Employer-Provided Health Insurance Offer and Coverage (or alternatively, Form 1095-B Health Coverage). The form you receive depends on what type of employee you were classified as during the previous tax year and the medical plan in which you are enrolled.
Why am I receiving an IRS Form 1095?
You will need the information from your IRS Form 1095-C or 1095-B when you complete your Federal income tax return. The 1095-C form provides documentation of employer-provided health coverage offered to you, as well as enrollment information for you and your dependents as required under the employer shared responsibility provision of the Affordable Care Act (ACA).
If your employer provided you or your family members with health coverage through a fully-insured health plan, such as Kaiser, the sponsor of the plan providing the coverage will furnish you information about the coverage separately on Form 1095-B.
You may receive more than one of these Forms if you changed employers or medical plans mid-year.
What am I supposed to do with the Form 1095?
The IRS Form 1095 will be used to complete your U.S. individual tax return. If you receive a tax credit or premium subsidy under the ACA, the form may be needed to complete applicable tax forms.
Otherwise, simply keep the form as your “proof of coverage” for the ACA individual mandate. At this time, you are not required to submit it to the IRS with your tax return.
I received two 1095s even though I had the same coverage all year.
Employers issue Form 1095s according to each Employer Identification Number (EIN), under which they operate. If you changed jobs during the year, and that puts you in a part of the Stanford group of employers with a different EIN, you will receive a Form 1095 for each EIN of the same company. This may also occur if the employer reorganizes itself, even if you have the same job.
Why did I get more than one Form 1095?
There are several reasons why you would receive multiple Form 1095s.
The first has to do with how your medical plan is financed by your employer. Some plans are “fully insured” (e.g. Kaiser) while others are “self-insured.” The IRS requires different Form 1095s depending on what kind of plan you are in.
Your employer will issue a Form 1095-C to all current and former fulltime employees who were eligible to enroll in the employer’s medical plan in the prior calendar year. So, if you were a full time employee, you will receive a Form 1095-C from your employer whether or not you enrolled in the employer’s coverage.
Even if you are currently on COBRA or are a retiree, if you were a full-time employee at any point during the prior year eligible to enroll in an employer’s plan, you will receive a Form 1095-C.
If your employer has a fully insured plan (e.g. Kaiser), the plan’s insurance carrier will issue Form 1095-B for anyone enrolled in the plan for even one day of the prior year, regardless of their employment status.
This means that employees and former employees who were full-time during the prior year and enrolled in a fully-insured plan will always receive two Form 1095s, a 1095-B and a 1095-C.
You may also receive two forms for several other reasons: (i) if you changed employers during the year; or (ii) though you did not change employers, your same employer began to use a different employer identification number (EIN) during the prior year.
I received a Form 1095 but was not enrolled in this employer’s coverage.
Your employer is required to send a Form 1095 to all full-time employees regardless whether an employee enrolled in coverage. The form shows whether employer coverage was offered and, if so, whether the employee enrolled in it.
Why is my insurance premium higher than what is showing on the form?
The form will show the lowest cost for the employee-only coverage level. If you are covering dependents or are not enrolled in the lowest cost employee -only coverage, your cost may be different.
Why is this Form 1095-C partly blank? I had coverage for myself and my dependent for the entire year.
This form will only contain information for the months you were covered under a self-insured plan in the prior year.
If you were enrolled in a fully insured plan for any part of the prior tax year, the insurance carrier will send you a separate Form 1095-B or 1095-C showing the period you were enrolled in that fully insured plan.
What if information in my 1095 statement is incorrect or I disagree with the information?
Please contact the HR Service Team and a specialist will assist you in researching and resolving your concern.
What is a 1095-B?
You will receive a 1095-B from your insurance carrier if you were:
- A full-time or part-time employee enrolled in fully-insured coverage for even one day of the prior year
- On COBRA and were a full-time or part-time employee enrolled in a fully-insured plan for even one day of the prior year, regardless of whether you were employed full time or part time during the year
- A dependent of a former employee and were enrolled under COBRA in a fully-insured plan for even one day of the prior year.
- A Retiree under the age of 65 enrolled in a fully-insured plan for even one day of the prior year, regardless whether you were employed full-time or part-time during the year
- A dependent under the age of 65 of a Medicare-eligible Retiree and enrolled in a fully-insured plan for even one day of the prior year.
You will receive a 1095-B from Medicare if you were a Retiree age 65 or over, and were enrolled in an employer’s Medicare supplement plan for even one day of the prior year, regardless whether you were employed full-time or part-time during the prior year.
Where can I learn more about the IRS Form 1095?
For questions about the IRS Form 1095, contact the IRS Tax Help Line at 800-829-1040 (Mon-Fri, 7:00 a.m. – 7:00 p.m. local time), or visit the IRS website to find information about your tax reporting and Individual Shared Responsibility obligations and other information about the Affordable Care Act.
Does the IRS Form 1095 apply only to employees on Stanford payroll?
All full time employees paid by Stanford and other individuals covered by Stanford’s self-insured medical plans will receive an IRS Form 1095-C from Stanford. Employees and other individuals covered by the Kaiser plans will receive Form 1095s from Kaiser. This includes terminated and retired employees who worked at Stanford during the tax year, employees continuing medical coverage through COBRA and retirees under age 65.
What is the ACA Portal and how do I log in?
The ACA 1095 Portal is where Stanford University regular employees can access the Form 1095-C to view and download. The ACA Portal is now accessed through My Benefits and provides the opportunity to “Go Green” and consent to electronic delivery (e-delivery) of the Form 1095-C. With e-delivery, when the 1095-C is available, you will receive an email with a link to download and print your Form 1095-C. If you do not select e-delivery as your delivery preference by the first week of January, your Form 1095-C will be provided by U.S. Mail by the end of January. Postdoctoral students, former employees and other individuals covered or offered coverage will receive their Forms via U.S. mail, even if electronic delivery was previously elected.
Will employees that recently retired get two forms – one from Stanford as an employee and one reflecting retiree coverage?
If you retired in the tax year and were enrolled in one of Stanford’s self-insured plans before and after retirement, you will receive one Form 1095-C reflecting the full tax year. However, if you changed between a self-insured plan and a fully insured plan, such as Kaiser, you may receive a Form 1095-C from Stanford for the portion of the year you were employed and were enrolled in the self-insured plan and Form 1095-B from the medical plan insurer for the period of time you were enrolled.
ACA Medical Plan Questions
Can I keep my Marketplace Plan (i.e. CoveredCA plan) instead of enrolling on a university plan?
You can always choose to have a Marketplace Plan (such as a Covered California plan) regardless of whether or not you are working, instead of a plan offered through Stanford University. The cost of a Stanford plan for a part time employee could be more than the cost of a Marketplace plan. However, if you are receiving a premium discount (or premium tax credit) towards your Marketplace plan while working full time, this could result in a tax penalty to you. It's not the enrollment in the Marketplace plan, but the discount/credit while working full time that becomes a tax issue. If you are not working full time, the IRS allows you to continue receiving any appropriate premium discount or request the tax credit. The discount, or tax credit, may change if you have a change in income level.
What is Stanford's ACA Plan and how much will it cost me?
Stanford’s ACA Plan is a high deductible health plan for Stanford’s full time contingent employees, such as full time temporary, casual and student employees. The ACA Plan meets the ACA’s requirements of affordability, minimum essential coverage (MEC) and minimum value (MV). The ACA Plan provides two levels of coverage, Employee Only and Employee & Child(ren).
In accordance with the ACA affordability rules, the semi-monthly cost to the employee for the Employee Only level of coverage will be less than 9.67% of the Federal Poverty Level (indexed). The cost for the Employee & Child(ren) level will be greater. For instance, in 2017 the semi-monthly cost for Employee Only coverage was $44.77 and for Employee & Child(ren) coverage was $268.80. If you are determined to be an ACA-Eligible employee, you will be notified of the ACA Plan’s current year rates by Stanford’s Benefits administrator. You can view the current plan rates here.
Can I cover my spouse on the ACA Plan?
No, the ACA requires employers to offer minimum essential coverage (MEC) to full-time employees and their eligible dependent children up to age 26. Therefore, the ACA Plan for contingent employees does not provide spousal coverage.
How do I enroll in the ACA Plan?
If it has been determined that you are eligible to enroll in the ACA Plan you will be notified by Stanford’s Benefits administrator of when your eligibility begins and how to enroll if you choose to do so. ACA-Eligible employees will have an Open Enrollment period each year in the fall for coverage beginning January 1 of the following year.
Enrollment may be completed online through the My Benefits portal. Login to My Benefits using your SUNet ID and password or University ID and PIN.
Other ACA Questions
What happens to my medical plan payroll deductions if I don’t get a regular paycheck?
ACA Plan medical deductions are through Payroll deduction. If you do not receive a paycheck for a pay period, or if your paycheck is too low to take a full medical deduction, the “not taken” amount of your medical deduction will be held in the payroll system to be deducted as a lump sum when paychecks resume.
ACA Eligible Questions
What does ACA-Eligible mean?
In accordance with the Affordable Care Act (ACA) employer mandate, Stanford University must offer certain full time employees and their dependent children employer-sponsored medical coverage. Employees that meet or have met the requirement of 30 or more service hours per week on average are considered ACA-eligible and qualify for medical coverage.
How do I know if I’m an ACA-Eligible Employee?
If you are a contingent employee and expected to work 30 hours or more per week (on average), you may qualify for medical coverage either through Stanford or your employment agency. If Stanford is required to offer you medical benefits you will receive notification by Stanford’s Benefits administrator. When you are notified, you will be able to elect Stanford medical coverage to begin after your waiting period (at the 4th month of employment).
Annually, ACA-Eligible employees will be identified by looking back at hours worked for Stanford between October of the current year to October of the prior year. If during that time you averaged 30 or more hours per week, you are an ACA-Eligible employee and qualify for Stanford medical coverage. You will be contacted by Stanford's Benefits administrator at the end of the year and be able to elect medical coverage in December for coverage to begin January 1.
What period is the 30-hour average? Is it over a year?
There are three methods for determining eligibility under the ACA. The first method is when a contingent employee is hired by Stanford into a position that is expected to average 30 or more hours per week based on the standard hours entered into Stanford’s HR Management System (HRMS), the employee is determined to be ACA-Eligible for coverage beginning the 4th month of employment.
The second method is if the contingent employee is not hired into a position that’s expected to average 30 or more hours per week, a “look back” is conducted over the first year, anniversary date back to hire date, to determine if the contingent employee averaged 30 or more hours per week based on the actual time worked for Stanford. If so, the employee is ACA-Eligible for coverage beginning the first of the month following the anniversary date.
The third method is by conducting an annual “look back” at the hours worked for Stanford over the past year (from October to October), to determine if the contingent employee averaged 30 or more hours per week based on the actual time worked. If the hours average 30 or more per week, the employee is ACA-Eligible for coverage beginning January 1 of the following year.
How will ACA-eligible employees receive information about enrollment?
ACA-Eligible employees will receive information about enrollment from Stanford’s Benefits administrator when they are determined to be ACA-Eligible. This may be at hire, at first anniversary, and at the end of the year after the annual “look-back”.
How will the hours of employees that work in several departments be counted?
There are some employees who work for more than one department but under 30 hours per week for each. All hours worked across all departments will be aggregated. If the total is 30 or more, the employee will be considered ACA-Eligible and offered the opportunity to enroll for medical coverage.
I am a newly hired temporary employee. How will I know if I’m eligible for the ACA Plan coverage?
If it is determined that you are eligible for medical coverage under the ACA, you will receive a formal notification from Stanford’s Benefits administrator with information about the ACA Plan and how to enroll in medical coverage.
Do I have to elect medical coverage through Stanford?
No, you are not required to enroll for the medical coverage that is offered to you through Stanford. Stanford is required to offer you the opportunity to enroll if you are determined to be eligible under the ACA. You should compare the Stanford coverage and cost with privately insured plans, Health Plan Marketplace exchange options and plans offered through Covered California.
Whether you elect Stanford coverage or not, Stanford will still provide you the IRS Form 1095-C each January, which notifies you of the coverage made available to you in the prior year.
If I’m covered through my spouse/domestic partner’s health coverage, what do I need to do?
If you are covered through your spouse/domestic partner’s health coverage, you do not need to enroll in Stanford coverage. Although the ACA requires individuals to maintain medical coverage, you are not required to enroll in a medical plan offered by Stanford. If you are a full time employee and choose not to enroll in Stanford’s medical coverage, you should select “Waive Coverage” as your medical plan option. Even if you do not enroll in Stanford coverage, if you are a full time employee, Stanford will still provide you the IRS Form 1095-C each January. The 1095-C notifies you of the coverage made available to you by Stanford in the prior year.